Forgive me for worrying about the lack of philosophy and ethics in science and healthcare today.
This was a kind of experimental film where I combined an old audio track (narrator and choir) with some of John Berger’s words from “Here is where we meet”. I was perhaps trying to follow John Berger’s statement that he “risks to write nonsense these days”
The audio track is from this film by me: Oor auldest relative (made 2 years ago)
The words are by John Berger from “Here is where we meet” (just recently read by Peter)
This was filmed at Stirling castle in the old cemetery and features the Martyrs monuments.
So what might this film be about? Well I have no religious faith so it is not about that. Perhaps it is about learning over time? Perhaps it is about the meeting of Philosophy with Science? Perhaps it is about wounds and how we react to them? Perhaps it is about how poetry can convey briefly what other disciplines of thought may struggle with? Or perhaps it is about all of these and more? Though, rest assured this film does not offer an overall Philosophy!
At the beginning of June 2008 I sent an e-mail to Dr Leon Eisenberg, a former child psychiatrist, and a man of philosophy and science:
Dr Eisenberg was then 89 years old and I wanted to convey how important his writings had been to me:
I did not expect a reply:
A year later Leon Eisenberg died.
After his death a memoir was discovered: which Eisenberg had named “Were We Asleep at the Switch?”.
Eisenberg suggested that a switch from ‘mind’ to ‘body’ has taken place in psychiatry as a discipline, which has led to overuse of medication.
He also argued that “monied interests” had been making de facto decisions on behalf of us all about the “science” of things that might affect us.
Eisenberg was worried that the overwhelming impact of economic considerations may have rendered, and might continue to render futile, the professional contributions of many brilliant, timely, and concerned working scientists.
I need ethics because I am on my own.
I can only see with my own eyes.
I try to shift my stance.
I do not always see what others see
I need ethics because I am ordinary and extraordinary.
I can only see with my own eyes
I try to shift my stance
I do not always see what others see
[and then there is feel]
On Friday the 25th of November 2016 I gave a talk for the Scottish Philosophy and Psychiatry Special Interest Group.
My subject was “Improvement Science”.
The following is based on the slides and the four short films that I presented.
My talk was entitled:
The meeting was held at the Golden Lion Hotel, Stirling:I started the day off:
I gave these declarations:
I explained to the audience that like Dr Rev I M Jolly I can be overly pessimistic:
The dictionary definition of ‘Improvement’:
The dictionary definition of ‘Science’:
My concern is any pre-determinism to science:
The Health Foundation have considered Improvement Science: this is from 2011:
Many different terms are used including “QI” for “Quality Improvement”:
This is where improvement science began, in Boston, Massachusetts:
The Founder of the Institute for Healthcare Improvement (IHI) was Don Berwick:
The first description of this movement in Britain goes back to 1992 by Dr Godlee:
Fifteen years later, Dr Godlee, Editor of the BMJ, said this:
Only last month the BMJ briefly interviewed Don Berwick:
IHI describes improvement science as being based on a “simple, effective tool”:
This tool was developed from the work of an American engineer, W. A. Deming:
The “Model for Improvement” Tool [TM] is described by IHI as a “simple, yet powerful tool”:
The current President and CEO of IHI is Derek Feeley:
Up until 2013, Derek Feeley was Chief Executive [Director General] for NHS Scotland:
In April 2013 Derek Feeley resigned from NHS Scotland:
22nd February 2015 it was reported: “The astonishing and largely hidden influence of an American private healthcare giant at the heart of Scotland’s NHS”:
Dr Brian Robson, Executive Clinical Director for Healthcare Improvement Scotland [HIS] is an “IHI Fellow”:
Professor Jason Leitch, National Clinical Director for the Scottish Government is an “IHI Fellow”:
Might we be facing the biggest change to healthcare in Scotland since the NHS began? Improvement science is moving quickly and widely across Scotland:
This “Masterclass 1” for Board members cost £146,837:
An NHS Board member commented after the Masterclass:
Healthcare Improvement Scotland is one organisation with a very wide remit over NHS Scotland and it works closely with the Scottish Government:
Nine cohorts of Safety Fellows and National Improvers have so far been trained following IHI methodology:
I was reminded of the current enthusiasm for improvement science when the Convener of a recent Scottish Parliament Committee meeting said of targets (another approach enthusiastically taken by NHS Scotland):What is the place of ethics in Improvement Science?
In 2007 the Hastings Centre, USA, looked into this in some depth:
The Hastings Centre argue that Improvement science cannot ignore ethics:
In 2011 the Health Foundation, UK, produced this “Evidence Scan”:The Health Foundation commented that “improvement science is just emerging”:
The Evidence Scan found a “real paucity of evidence about the field of improvement science”:
I would also suggest that there is a real paucity of philosophy about the field of improvement science:
The Health Foundation did find papers on the conceptual nature of Improvement Science but concluded that:
Mary Midgley is a philosopher now aged 95 years who is widely respected for her ethical considerations:
Chapter 7 of her book “Heart and Mind: The Varieties of Moral Experience” begins:
Mary Midgley is concerned about the overuse of reductionist tests in medicine stating that:
This film is about the potential consequences of inappropriate reductionism:
Leon Eisenberg has written many papers about this subject. He argues that reductionism should not be “abandoned” but that we must keep sight of where such an approach is scientifically useful and also where it is inappropriate:
In the Hastings Report, Margaret O’Kane asks:
In my view the answer to this question is YES. I am hopeful that the National Improvers recruited to NHS Scotland would agree:
As an NHS doctor I have seen unintentional harm brought about by National improvement work in Scotland. This related to a “Screening Tool” that was introduced across Scotland as part of this work. I found that the unintended consequences of the use of the following tool included implications for patients’ autonomy and the risk of over treatment:
Both the Hasting Group and the Health Foundation are of the view that improvement science cannot separate itself from the ethical requirements of research:
This article published in February 2016 argues that individual “rights transcend all aspects of Improvement science”
The following is a verbatim representation of a conversation held by National Improvers working in NHS Scotland:
In November 2016 Professor Joshi, also a psychiatrist outlined his concerns about reductionism in a published letter to the BMJ:
In this short film the mechanical language of healthcare improvers is considered:
Professor John Bruce was a Moral Philosopher in Edinburgh University in the 18th century. He built this temple, the “Temple of Decision”, in the grounds of his home by Falkland Palace so that he could consider his thesis:
Professor John Bruce did not succeed in his endeavour. His Temple however stood for many years:
But it eventually collapsed and his endeavour to “reduce the science of morals to the same certainty that attends other sciences” collapsed with it.
Any search of Healthcare Improvement Scotland for “ethics” finds this result:
This film is about more up-to-date buildings – the enthusiasm for which was based on improvement science: The Red Road flats in Glasgow:
The following is an edited clip of the evidence given to the Scottish Parliament by Healthcare Improvement Scotland (HIS) on the 31st January 2017:
The full session can be watched here
The Official Report can be accessed here
This is a more experimental film and is based on attending a Conference by Aberdeen Council on the 27th October 2016 in the old Anatomy Department of Marischal College.
The Conference was on “customer experience” and was extremely well put together. This meeting truly realised the benefits of shared learning and wider thinking. I felt very lucky to be a part of it.
I gave a brief 5 minute talk on “bedside manner” in the old dissecting room where 28 years ago I had learned anatomy.
One of the talks I most benefited from was by the philosopher Dr Bob Plant. His talk made me think of divides – the dissections of understandings. The film ends with dissections on the body of “Caledonian Antisyzygy”.
This film begins with my friend Dr Flaxman going up in the old lift to the Town House Archives. We had just left another lift behind, the lift in the Anatomy Department where bodies were brought up to the “Drain”. That is why I have called this film “The Body Lift”